Provider Demographics
NPI:1508511981
Name:SPINE BODY & SOUL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SPINE BODY & SOUL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-392-5640
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-0479
Mailing Address - Country:US
Mailing Address - Phone:405-392-5640
Mailing Address - Fax:
Practice Address - Street 1:6917 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8582
Practice Address - Country:US
Practice Address - Phone:405-392-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty